Insulin pen, box: open box or not? Rite Aid Old Memo of 2013?

[josh6718]

Laws need changed first and with people thinking pharmacists need to only review so per day, law changes are far away.

True, though with as much money as he (and Amazon) has, its still concerning. Look what big Pharma did with Congress to the DEA on last month's 60 Minutes story.

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[Pharmanut]

No one is. What I don't get is what's up with all the personal attacks? I mean you created a whole new account to attack me just because no one is agreeing with you. You're doing something that is out side of standard practice. People are not going to do that; so you should understand. It seems you have too much emotion riding on this thread. The bottom line is, we'll continue doing what we are doing and you do you...okay? It seems like after 6 pages of back and forth, no one is biting so you should give up and move on to greener pasture.

Wow.. you do realize more people are for opening boxes since I started than not. Unless you count me josh and everyone else as the same person.

 

[Lnsean]

Who is on your side ? Multiple people have said they now open boxes. Multiple people have shown you evidence and actual documents. How do you reply? The same rhetoric. “Standard of practice” and “no one is on your side”. Its as if you are a man child and it scares me that you were actually in charge of a pharmacy. Your reasoning is worthless as you keep referring to people on this board while we show you hard proof. Well, I am done here folks. I will now transform back to Josh “lmao”

LOL why are you so angry though? All i said is let's agree to disagree. It's obvious no one is on your side. Just read through the thread. LOL. Move on. The majority of pharmacists will continue to dispense full boxes because there's no issue with that.

 

[Pharmanut]

Please stop calling your colleagues robots. It is disrespectful.

Lsean is not a colleague. This is a terrible insult and I ask you take it back

 

[josh6718]

No one is. What I don't get is what's up with all the personal attacks? I mean you created a whole new account to attack me just because no one is agreeing with you.

 

[Lnsean]

Wow.. you do realize more people are for opening boxes since I started than not. Unless you count me josh and everyone else as the same person.

Ummm no. Everyone has contradicted you...even people at CVS. Look through the thread.

 

[josh6718]

Ummm no. Everyone has contradicted you...even people at CVS. Look through the thread.

They're probably all fake accounts you made...

 

[Pharmanut]

Ummm no. Everyone has contradicted you...even people at CVS. Look through the thread.

You are seriously delusional. Are you talking about people from 2015? Josh and I were only one person back then

 

[Lnsean]

You are seriously delusional. Are you talking about people from 2015? Josh and I were only one person back then

LOL okay...you continue splitting boxes and everyone else will continue to dispense full boxes. We good here?

 

[Pharmanut]

LOL why are you so angry though? All i said is let's agree to disagree. It's obvious no one is on your side. Just read through the thread. LOL. Move on. The majority of pharmacists will continue to dispense full boxes because there's no issue with that.

This is not even about insulin pens anymore. The reason I will not just sit back and allow you to spread lies is because your reasoning and lack of interpretation of pharmacy dispensing is what is the problem with today’s retail pharmacist. You do not want to think outside the box. You allow these big retail chains to become profitable at your own expense. I would not allow such a thing to happen and I honestly believe Walgreens has corrupted your mind

 

[Lnsean]

This is not even about insulin pens anymore. The reason I will not just sit back and allow you to spread lies is because your reasoning and lack of interpretation of pharmacy dispensing is what is the problem with today’s retail pharmacist. You do not want to think outside the box. You allow these big retail chains to become profitable at your own expense. I would not allow such a thing to happen and I honestly believe Walgreens has corrupted your mind

So now it's not insulin pens? LMAO. About time you admitted to losing the argument. Yea, we can discuss something else then. Again, sooo personal. Who hurt you tho?

 

[Pharmanut]

Ummm no. Everyone has contradicted you...even people at CVS. Look through the thread.

You’ve only contradicted yourself. I now Work at a hospital and we open insulin boxes and everything else that could be opened without any issues. The drug reps have agreed that this is OK so who are you to tell us that it’s not

 

[Lnsean]

You’ve only contradicted yourself. I now Work at a hospital and we open insulin boxes and everything else that could be opened without any issues. The drug reps have agreed that this is OK so who are you to tell us that it’s not

Hospital is different. Patients are being monitored; it's inpatient. No one here is going to send John home with lose Humalog pens at retail setting. BUT why are you going back to insulin pens? I thought you conceded the topic.

 

[Pharmanut]

So now it's not insulin pens? LMAO. About time you admitted to losing the argument. Yea, we can discuss something else then. Again, sooo personal. Who hurt you tho?

You lost this argument two years ago and you keep going on. For two years you have been on this And I have only been out for two days. Pretty pathetic ha ha. Look like you’re the only one that’s hurt

 

[Lnsean]

You lost this argument two years ago and you keep going on. For two years you have been on this And I have only been out for two days. Pretty pathetic ha ha. Look like you’re the only one that’s hurt

You conceded the argument first. I can quote you.

 

[Pharmanut]

Hospital is different. Patients are being monitored; it's inpatient. No one here is going to send John home with lose Humalog pens at retail setting. BUT why are you going back to insulin pens? I thought you conceded the topic.

With “lose” humalog? God help us

 

[Lnsean]

With “lose” humalog? God help us

So now you're going after typos? LOL

 

[wagrxm2000]

This thread may never end.

Someone needs to give in and just not respond.

 

[Lnsean]

I mean he already conceded the argument on insulin pens. We're just discussing typos and semantics now.

 

[Pharmanut]

This thread may never end.

Someone needs to give in and just not respond.

Here I will end it now. Multiple documents multiple people in multiple insurance companies have a greed it is OK to open up insulin boxes. The argument that is presented by Lsean replicates that of a High school student. To him it is more important to use standard of therapy, this message board and ridiculous claims of patient safety over actual insurance documents package inserts, Pharmaceutical reps in hospitals, other retail chains besides Walgreens and common sense. There is no argument here, only one idiot who loves to be a troll and make up garbage. I will gladly discuss this with anybody else here but arguing with a child is no longer an option for me.

 

[Lnsean]

Here I will end it now. Multiple documents multiple people in multiple insurance companies have a greed it is OK to open up insulin boxes. The argument that is presented by Lsean replicates that of a High school student. To him it is more important to use standard of therapy, this message board and ridiculous claims of patient safety over actual insurance documents package inserts, Pharmaceutical reps in hospitals, other retail chains besides Walgreens and common sense. There is no argument here, only one idiot who loves to be a troll and make up garbage. I will gladly discuss this with anybody else here but arguing with a child is no longer an option for me.

It's not up to the insurance to determine that; it's clearly a violation of patient safety. You've probably been splitting insulin boxes for everyone for a couple years and now have a record of thousands of misfilled prescriptions where patients are not getting the proper documentation from the manufacturer. That's why I sense you are angry and defensive. That's why no one else is doing this except for a selective few rare instances where that 1 plan requires it. And anyone that even splits a box of insulin should be mindful to document that on the hardcopy that you provided consultation to the patient. I don't think you did any of this because you thought it was just whilly-nilly throwing a couple loose pens into a zip lock. That's what I think happened and is causing you to be so defensive.

There's no need to convince anyone here it's okay to split boxes. We have our own judgment. It;s your call.

 

[Pharmanut]

It's not up to the insurance to determine that; it's clearly a violation of patient safety. You've probably been splitting insulin boxes for everyone for a couple years and now have a record of thousands of misfilled prescriptions where patients are not getting the proper documentation from the manufacturer. That's why I sense you are angry and defensive. That's why no one else is doing this except for a selective few rare instances where that 1 plan requires it. And anyone that even splits a box of insulin should be mindful to document that on the hardcopy that you provided consultation to the patient. I don't think you did any of this because you thought it was just whilly-nilly throwing a couple loose pens into a zip lock. That's what I think happened and is causing you to be so defensive.

There's no need to convince anyone here it's okay to split boxes. We have our own judgment. It;s your call.

What patient safety?? Explain what exactly you think is making it unsafe and stop making arguements that make no sense. What proper documentation? We give them the package insert in every fill. Explain yourself and stop with the garbage replies without any backing.

 

[Lnsean]

What patient safety?? Explain what exactly you think is making it unsafe and stop making arguements that make no sense. What proper documentation? We give them the package insert in every fill. Explain yourself and stop with the garbage replies without any backing.

Bro, all this is on you. Not me. You're the one that's splitting up the boxes, you should look that up. I don't have any problems with filling full boxes, the insurance companies already told me I'm good. This is all you....lol.

 

[Pharmanut]

Bro, all this is on you. Not me. You're the one that's splitting up the boxes, you should look that up. I don't have any problems with filling full boxes, the insurance companies already told me I'm good. This is all you....lol.

Hahhahahahah hahahhahahhha. I ask you to explain your words and you can’t even do it. You are proving more and more how incompetent you are. Once again. Explain your patient safety comment so I can make you look like a fool.

 

[Lnsean]

Hahhahahahah hahahhahahhha. I ask you to explain your words and you can’t even do it. You are proving more and more how incompetent you are. Once again. Explain your patient safety comment so I can make you look like a fool.

I have no beef in this. I'm already cleared. What I am doing is fine with the insurance companies and conforms to standard procedure. You, on the other hand, are deviating from standards and should make sure to cover yourself. It's probably thousands of scripts you've misfilled. lmao.

 

[josh6718]

It's probably thousands of scripts you've misfilled.

 

[CynicalIntern]

I wish I cared about anything as much as you guys care about insulin pens.

 

[Sine Cura]

All right so Walmart just updated their pharmacy operation manual to state explicitly that boxes of insulin pens should be broken to conform to maximum day supply allowed and you also have to provide the patient information with each dispensing (IIRC I am not at work). For those of you breaking boxes, do you actually have a stack of patient information for this. This is not a situation like with Nitrostat where there is a guide for every vial... there is literally only one package insert and one directions for use insert for each box.. ugh...

I'll scan this doc later

 

[wagrxm2000]

All right so Walmart just updated their pharmacy operation manual to state explicitly that boxes of insulin pens should be broken to conform to maximum day supply allowed and you also have to provide the patient information with each dispensing (IIRC I am not at work). For those of you breaking boxes, do you actually have a stack of patient information for this. This is not a situation like with Nitrostat where there is a guide for every vial... there is literally only one package insert and one directions for use insert for each box.. ugh...

I'll scan this doc later

Oh man, here we go again.

 

[Pharmanut]

Oh man, here we go again.

I told you! I win again. When will you all admit it? Where is that no good lnsean? Also, Sine Cura.. I would not post any internal documents a company has put out. I am sure it is interesting but they can find you and sue you. Just an FYI

 

[josh6718]

Oh man, here we go again.

 

[josh6718]

For those of you breaking boxes, do you actually have a stack of patient information for this. This is not a situation like with Nitrostat where there is a guide for every vial... there is literally only one package insert and one directions for use insert for each box.. ugh...
I'll scan this doc later

CVS recently just updated its system to print patient information handouts for almost everything imaginable now. I filled a script the other day for three Suboxone strips and when I printed the label it was followed by 12 or more pages of front and back 'patient information' (Keep in mind the patient had already been prescribed and using this medication for years). This was then followed by a 3 foot long receipt at the register.

 

[wagrxm2000]

Man if only Walgreens would let me open a box.......

 

[CynicalIntern]

Man if only Walgreens would let me open a box.......

I mean this is 100% a thing, and you're right about it.

That said, I would not be surprised at all if when Express Scripts comes auditing, they hit independents a lot more finicky than they do Walgreens because 1) They know they'll be able to find a lot more high dollar chargebacks with Walgreens since the RXM doesn't have any skin in the game and isn't going to track down a nurse for a new prescription, and 2) Walgreens has the infrastructure to challenge it with legal suits on precedent if need be, whereas your independents don't have that sort of clout.

 

[Lnsean]

Why is this still being debated. If you want to open the box, go ahead. That's on you. Know that you are doing something outside of standard of practice, so you better cover your ass. For everyone else, we'll continue to give the full box until standard practice changes.

 

[BidingMyTime]

I probably already posted on this thread years ago, but I don't have time to read all 7 pages to check.

So I'll just say, I have never heard of opening up pen boxes in real life . The boxes seem pretty clear to me that they are designed for direct dispensing to a patient. I have also never seen a chargeback on giving an entire pen box (granted I don't usually see chargebacks.....but I'm pretty sure if any pharmacy I'd worked at had gotten one, they would make sure everyone on staff knew that opening up boxes was now required.

Do you guys who open up pen boxes, also open up estrogen patch boxes or other unit dose patient packages?

 

[BidingMyTime]

You’ve only contradicted yourself. I now Work at a hospital and we open insulin boxes and everything else that could be opened without any issues. The drug reps have agreed that this is OK so who are you to tell us that it’s not

Plus, I've never seen a hospital that used insulin pens. Why is your hospital using insulin pens? Baby vials are cheaper, plus you don't have to worry about the contamination issues of nurses leaving pens laying around when they aren't supposed to and then using the pen on the wrong patient. The only situation I can imagine using a pen in the hospital in, is if for some reason the vials were back-ordered and that was the only option--and I've never seen that happen.

 

[josh6718]

Do you guys who open up pen boxes, also open up estrogen patch boxes or other unit dose patient packages?

Don't think I can remember coming across any scripts that were for less than a full box of estrogen patches, but we did for others (i.e. lidocaine patches, nicotine patches, fentanyl, scopolamine, flector patches, etc.). This was when I was working in the midwest. Working down south the stores in the district did the above plus open boxes of pen needles.

 

[Rouelle]

As I float retail, I occasionally see scripts for fentanyl patches in quantities that are not multiples of 5. I always ask the store’s regular employees whether they will open a box. I would say it’s a 50/50 split.

 

[Dr. Pill]

Plus, I've never seen a hospital that used insulin pens. Why is your hospital using insulin pens? Baby vials are cheaper, plus you don't have to worry about the contamination issues of nurses leaving pens laying around when they aren't supposed to and then using the pen on the wrong patient. The only situation I can imagine using a pen in the hospital in, is if for some reason the vials were back-ordered and that was the only option--and I've never seen that happen.

Only speaking from experience but my hospital uses pens due to 340B contract prices being cheaper. Can get a box of pens for less than a few bucks.

 

[wagrxm2000]

Starting now, Walgreens requires boxes to be opened so insurance can be billed properly.

 

[CetiAlphaFive]

Starting now, Walgreens requires boxes to be opened so insurance can be billed properly.

RIP your inventory (and customer service metrics)


"I always gets de whole box befohr.
Why you no gieb it to me now?"

 

[nsansom15]

Starting now, Walgreens requires boxes to be opened so insurance can be billed properly.

I have had these past couple of days off, when did this get announced?

 

[RxRetailRx]

on PPLs will starting April 2018...

 

[wagrxm2000]

I have had these past couple of days off, when did this get announced?

It's live now but will start being CAP blocked in April

 

[maria1oh]

Envision rx plans (insurance company owned by rite aid) will audit you on breaking insulin boxes.
So far none of the other insurances have officially announced it as far as I know. I know some are ok with it as long as the actual day supply is documented and you are not filling it too soon.

 

[SoylentGreen]

Starting now, Walgreens requires boxes to be opened so insurance can be billed properly.

Same at Walmart, though Walmart management is rather ineffective and I doubt most of the stores will follow the new rule.

 

[Charcoales]

Starting now, Walgreens requires boxes to be opened so insurance can be billed properly.

Yeah saw this, was very very confused, we put them in a mix bag or something. What about if box and a half? Give 1 box and rest of pens in a mix bag or something?

 

[wagrxm2000]

Yeah saw this, was very very confused, we put them in a mix bag or something. What about if box and a half? Give 1 box and rest of pens in a mix bag or something?

Yeah that's what I would do.

 

[CetiAlphaFive]

What's next?

Are they gonna force you to squirt out half of the insulin if the 1 Pen is less than 28 days supply?